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DEATH
CERTIFICATE
AVON WALTERS
Date 25 August 1943
Cert: 21037
Place of Death: County: Perry City or
Town: Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Sassafras (Rural)
Full Name: Avon WALTERS
If Veteran Name War: No
Social Security No.: None
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: X
Age of husband or wife if alive: X
Birth date of deceased: 03 June 1929
Age: 14 years, 02 months, 22 days
Birthplace: Sassafras, Kentucky
Occupation: Student
Industry or business: "
Father Name: Willie WALTERS
Father Birthplace: Breathitt County, Ky.
Mother Maiden Name: Dulcina ARMSTRONG
Mother Birthplace: Breathitt County, Ky.
Informant: Eva Mae WORKMAN, Vicco, Ky.
Burial Place: Burial Sassafras Cemetery
Date: 28 August 1943
Signature funeral director: Maggard Funeral Home, Hazard, Ky.
Date received by local registrar: 11 October 1943
Registrar's Signature: Anna L. Boulos
Date of Death: 25 August 1943
I hereby certify that I attended deceased from 25 August 1943 to
25 August 1943, that I
last saw him alive on 25 August 1943, and that death occurred on the date
stated above at 4 p.m.
Immediate cause of death: Dysentery
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 30 August 1943
Transcribed by Debbie Tamborski, 06 February 2010 |
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